P H O T O E S S A Y

Figures 1a, 1b:

Here is an impression for a four unit bridge from a lower first molar to a bicuspid. The problem with
this impression is that it was taken with double arch impression tray. A double arch impression tray is
great for a single unit or 2 adjacent single units but this tray should never be used for four unit or any
kind of bridge like this(left). The other problem with this impression is when you roll this over and look
on the lingual of the molar (right), you will notice that we have got some of the tray showing thru
right at the lingual margin of that preparation. This is unacceptable–we need to have impression
material all the way around the lingual margin there and have no tray showing thru (especially when it
is in contact with margin of the preparation).
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Figure 2: Here is an
impression where double
arch tray was used to take an
impression for a long span
bridge. This triple tray, as you
can see, subsequently fell off
when the impression was
poured. This is not the main
problem here because you do
not get a lot of rigidity from a
plastic triple tray anyway. The
problem here is that triple
tray was used for this large
long span bridge. Let’s go
ahead and take a look the
models for this impression.
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Figures 3a, 3b: Here is the model work for that impression. When you look at this, the margins all look
good on the preparations. In fact, the preparations are nice–we got a nice path of insertions
here(left). The problem is the impression stops right here on the incisal region(right) and we do not
have anything on the other side of the arch. As result, when our dental technician tries to fabricate
this bridge they are not going to be able to place a good lateral excursive function into this bridge. So
the impression itself is ok except for the fact that we do not have any kind of guidance from the rest of
the teeth. This makes it unacceptable impression. This should have been taken with a full arch custom
tray on the lower arch.
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Figures 4a, 4b: Here is an exercise in frustration. This doctor had to take four impressions to try to
capture the margins in all the different teeth that were prepared. These are two full arch impression
and two full arch quadrant trays(left). No amount of impressions will make up for sloppy tissue
technique. As we look at just one tooth here (right), you can see a pull from the side of it here. This is
why I prefer the double cord technique that you will see in this presentation because this gives me a
much more predictable results. I do not want to take four impressions and still not be able to capture
all my preparations.
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Figure 5: Here is a solid model from
one of those four impressions and
you can see what the problem is
here. You can see a well defined
margin as we move along here and
simply disappears on the lingual. The
tissue on the lingual is seating up
against the margin and there really is
no way for us to guess on a case like
this and be able to trim the margin
for this dentist–there is a same
problem on the bicuspids as well. So
we have a bridge case here where we
clearly cannot see the margins 360
degrees around the tooth on any of
the preparations–again the Double
Cord Technique could have prevented
this.
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Figure 6: It is hard to say anything
good about an impression like this.
You would have to look at this once or
twice to decide which tooth has even
been prepared–it is this tooth right
here. As I turn this impression and
look around, there were no two
viscosities of impression materials
used: there was just one medium
body material squirted into the tray
and just pushed down onto tooth.
There simply is not any evidence of
tissue retraction either. A lousy
impression like this can only give you
a lousy model so let’s take a look at
the model.
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Figure 7: Imagine for a
moment that you are a
dental technician that this
model has been assigned to.
Obviously you are going to
have some questions–
mainly “where are the
margins?” would be the first
question that comes to my
mind. This would be very
difficult for the technician to
see where the margins are.
This will result a phone call
to the doctor and asking
him for a new impression.
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Figure 8: This impression
represents just sloppy tissue
management, sloppy impression
taking, massive amounts of pulls,
noise, voids and double
impressions over on this side. This
was a pre-impression that was
taken with a putty and was not
relieved consequently before
placing the light body impression
material in place. As a result, you
can see some of the teeth
adjacent to the preparation have
thin layers of light body material
in there. This is just not a great
impression. Let’s take a look at the
model.
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Figures 9a, 9b: As you would expect, the detail on this model is in short supply. Again, I have a difficult
time reading the margin around the entire circumference of the the preparation(left). As we turn it to
the side you can see the result of all the pulls and voids in the impression itself. It is really difficult to get
an idea of the anatomy of these adjacent teeth. This will make even more difficult to build correct
anatomical morphology.
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Figure 10: This is an example of a good use of
anterior double arch impression tray because of the
fact that we have just one tooth that has been
prepared. I can see all the margins as I look around
this impression(left)–it looks nice. I wish I could see
more impression beyond the margin so this tells me
this was done with one cord technique instead of
two cord technique. My one area of concern with
this impression is that when I hold it up and look
thru the area of bicuspids, I cannot see thru the
impression material. That tells me the patient was
not in maximum intercuspation when this tray was
in their mouth. So in case like this when you cannot
see thru there, we ask for a separate bite
registration and send it along with a case. I will then
use that information to mount the model. Let’s go
ahead and take a look at the model for this case.
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Figure 11: On the model, we

can see the shoulder margin
that the doctor has prepared
360 degrees around the tooth.
You can also see some anti
rotational grooves that the
doctor has placed into the
preparation and you will be
able to see why those are
there in a second.
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Figures 12a, 12b:

As I turn this model you can see how short the preparation is(left). If I just take a perio probe and try
to measure this preparation and it is about 3 mm long on the facial and it is less than that on the
lingual(right). So we have very little mechanical retention to help hold this crown in to place. What we
would prefer to see is to have the doctor place a couple of pins and a core buildup to build this
preparation back down to the level where it should be. Where should it be? Well if you look at this
adjacent unprepared tooth(tooth #9) and imagine taking 1.5 mm of incisal reduction, that is where
this preparation(tooth#8) should be. Right now it is 2 to 3 mm short of that at this time. As a result,
we are going to have to hope that our resin cement will retain this crown long term.
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Figures 10a, 10b: On this impression, I like the doctor’s selection of a large tray for a three unit anterior
bridge–that is fantastic. What I do not like about it is that this is a two step putty wash impression. I
would prefer light body material be syringed around the preparation while the putty had not set and be
placed simultaneously. What we see when it is set separately like this is delamination that occurs and
you can see how this green material peels right off (right) all around the periphery of the impression. If
this was done as a simultaneous putty wash impression, this will not happen when these two
impression materials set simultaneously. Let’s go ahead and take a look at this model.
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Figures 11: On the model, I
actually noticed some pulls in
the areas of preparation that I
did not notice on the
impression– it was much easier
to see on the model than on the
impression. Another thing that I
have noticed is how far sub
gingival these margins are. It is
always problematic when taking
impression when the margins
are 4 to 5 mm subgingival. This
makes it extremely difficult, if
not impossible, to get an
accurate representation of the
margins in the impression
material.
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Figures 12: Here is an
impression that looks very nice.
A stock metal tray was used for
a 10 unit full crowns that have
been prepared on a maxillary
arch. As I look around, I can see
not only the deep chamfer or
shallow shoulder margins but I
can see a small bit of material
extension beyond the margin.
This is going to capture some of
the root surface allow the
dental technicians to make an
ideal emergence profile on the
final restoration. Let’s go ahead
and take a look at this model.
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Figures 13: As expected, we

are clearly able to see the
margins in all these
preparations. It can be very
easy for the dental
technician to trim these dies
and design margins
correctly. But with these
types of preparation and
models, you can expect
crowns to go right into place.
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Figures 14a, 14b: These next two cases are highly unacceptable. This first one is for a single unit crown
and this is all that we have received from the doctor. As I flip this over you can see this is merely a bite
registration(right) that was extruded between the patient’s two teeth and then relined with some light
body impression material. We have no adjacent teeth to go by and no opposing teeth information–this
is the entire impression that we have received from the doctor. The chances of us making an adequate
restoration is slim to none.
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Figures 15: Like wise on this next
impression, this was taken without a
tray. Again, this is a bite registration
relined with light body syringe
material. This impression is even
worse than the previous one because
this one is for a three unit bridge. We
do not have a lot of adjacent teeth
information. We have nothing on the
other side of the arch because of the
flimsy nature of this. This is almost
impossible for a dental laboratory to
make a bridge that will function well
for this patient. Both of these
impressions will require the dentist to
take a new impression.